{
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"FirstLineMailingAddress": "21 W LAKESHORE DR",
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"MailingAddressCityName": "RANSOM CANYON",
"MailingAddressStateName": "TX",
"MailingAddressPostalCode": "79366-2517",
"MailingAddressCountryCode": "US",
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"FirstLinePracticeLocationAddress": "3233 63RD ST",
"SecondLinePracticeLocationAddress": "SUITE A",
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"PracticeLocationAddressStateName": "TX",
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"EnumerationDate": "08/03/2012",
"LastUpdateDate": "08/03/2012",
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"NPIReactivationDate": null,
"GenderCode": null,
"Gender": null,
"AuthorizedOfficialLastName": "JACKSON",
"AuthorizedOfficialFirstName": "CECILY",
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"AuthorizedOfficialCredential": "DDS",
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"Taxonomies": {
"Taxonomy": {
"TaxonomyCode": "1223P0221X",
"TaxonomyName": "Pediatric Dentistry",
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"LicenseNumberStateCode": "TX",
"PrimaryTaxonomySwitch": "Y"
}
},
"HealthcareProviderTaxonomyGroups": {
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"HealthcareProviderTaxonomyGroupDescription": "Single Specialty Group - A business group of one or more individual practitioners, all of who practice with the same area of specialization."
}
}
}
}